Myofibrosarcoma of the adrenal gland.

Adrenal masses have varying presentations. Most commonly, adrenal masses are discovered incidentally on CT or MRI during an evaluation for an unrelated complaint. Although the majority of these are nonfunctional cortical adenomas, hormonally active tumors and adrenocortical carcinoma must also be considered in the differential diagnosis. Rarely, retroperitoneal tumors may mimic an adrenal mass. We report a case of a 49-year-old man with anemia and weight loss who was found to have a large retroperitoneal mass arising from the adrenal gland. Surgical treatment involved en bloc resection of the right kidney, adrenal gland, segments 7 and 8 of the liver, and a portion of the right hemidiaphragm. Final pathology revealed a low-grade myofibrosarcoma. We believe that this is the first case report of a myofibrosarcoma of the adrenal gland. Myofibrosarcomas are rare malignant tumors composed of myofibroblasts that arise from the deep soft tissues. These tumors have a predilection for the head and neck, trunk, or extremities. Myofibrosarcomas can be differentiated from other sarcomas by immunohistochemical staining and pathologic features. We will briefly discuss the workup of an adrenal mass and focus on the diagnosis of myofibrosarcoma.

Exophthalmos secondary to aspergillosis in a cat.

Clinical signs of orbital disease include exophthalmos, strabismus, or, less commonly, enophthalmos. Fungal orbital disease is uncommon. A case of nasal, frontal sinus, and orbital aspergillosis in a cat is described. Diagnostics for exophthalmos and therapy for retrobulbar abscesses are discussed.

Surgical reconstruction of severe cicatricial ectropion in a puppy.

A three-month-old chow chow mixed-breed puppy was presented with severe cicatricial ectropion of the upper eyelids after being burned maliciously. The burn wounds healed by second intention with contracture, causing eversion, elevation, and immobilization of the upper eyelids. The puppy was unable to blink or close the upper eyelids due to cicatrix (i.e., scar) formation. Surgical repair using tissue-relaxing procedures was successful in reducing corneal exposure and improving the puppy's appearance.

Antacid-induced hypermagnesemia in a patient with normal renal function and bowel obstruction.

OBJECTIVE: To report a case of severe hypermagnesemia caused by magnesium hydroxide in a woman with normal renal function. CASE SUMMARY: A 42-year-old Hispanic woman with schizophrenia and bipolar affective disorder was transported from jail to the emergency department with confusion, abdominal pain, vomiting, and constipation. She had been treated in jail with magnesium hydroxide, ordered as milk of magnesia 30 mL po each night and Maalox 30 mL po three times daily. Additional medications included lithium carbonate 300 mg po three times daily, chlorpromazine 150 mg po three times daily, benztropine mesylate 1 mg po twice daily, and docusate sodium 100 mg po each morning. Her temperature was 35.1 degrees C, blood pressure 108/58 mm Hg, heart rate 112 beats/min, and respiratory rate 24 breaths/min. She would respond only briefly to voice or painful stimuli. Her abdomen was distended and diffusely tender. Laboratory tests included serum magnesium concentration 9.1 mEq/L (normal 1.3-2), blood urea nitrogen 16 mg/dL (8-22), creatinine 0.9 mg/dL (0.5-1.1), calcium 3.9 mEq/L (4.2-5.2), and lithium 1.0 mEq/L. A laparotomy was performed, and an adhesive band from a previous oophorectomy was found to be compressing the sigmoid colon. Hypermagnesemia, hypothermia, and hypotension continued in the intensive care unit. Despite successful treatment of the hypermagnesemia with calcium, intravenous fluids, and furosemide, the patient's cardiac rhythm degenerated into fatal, pulseless electrical activity on postoperative day 2. DISCUSSION: This case of severe hypermagnesemia from magnesium hydroxide ingestion illustrates many of the risk factors for hypermagnesemia in patients with normal renal function. People using magnesium-containing medications for relief of gastrointestinal distress may be at increased risk for hypermagnesemia. A brief review of magnesium physiology, clinical effects, and treatment is provided. Frequent use of the laboratory to identify hypermagnesemia is encouraged because it is often a clinically unexpected finding and responds well to early treatment.

A sorting nexin-1 homologue, Vps5p, forms a complex with Vps17p and is required for recycling the vacuolar protein-sorting receptor.

A number of the Saccharomyces cerevisiae vacuolar protein-sorting (vps) mutants exhibit an altered vacuolar morphology. Unlike wild-type cells that contain 1-3 large vacuolar structures, the class B vps5 and vps17 mutant cells contain 10-20 smaller vacuole-like compartments. To explore the role of these VPS gene products in vacuole biogenesis, we cloned and sequenced VPS5 and characterized its protein products. The VPS5 gene is predicted to encode a very hydrophilic protein of 675 amino acids that shows significant sequence homology with mammalian sorting nexin-1. Polyclonal antiserum directed against the VPS5 gene product detects a single, cytoplasmic protein that is phosphorylated specifically on a serine residue(s). Subcellular fractionation studies indicate that Vps5p is associated peripherally with a dense membrane fraction distinct from Golgi, endosomal, and vacuolar membranes. This association was found to be dependent on the presence of another class B VPS gene product, Vps17p. Biochemical cross-linking studies demonstrated that Vps5p and Vps17p physically interact. Gene disruption experiments show that the VPS5 genes product is not essential for cell viability; however, cells carrying the null allele contain fragmented vacuoles and exhibit defects in vacuolar protein-sorting similar to vps17 null mutants. More than 95% of carboxypeptidase Y is secreted from these cells in its Golgi-modified p2 precursor form. Additionally, the Vps10p vacuolar protein-sorting receptor is mislocalized to the vacuole in vps5 mutant cells. On the basis of these and other observations, we propose that the Vps17p protein complex may participate in the intracellular trafficking of the Vps10p-sorting receptor, as well as other later-Golgi proteins.

Intraocular silicone prosthesis implantation in eyes of dogs and a cat with intraocular neoplasia: nine cases (1983-1994).

OBJECTIVE: To determine the outcome of implantation of an intraocular silicone prosthesis (ISP) in the eyes of dogs and cats with intraocular neoplasia. DESIGN: Retrospective case series. ANIMALS: Eight dogs and 1 cat with histologically confirmed intraocular neoplasia. PROCEDURE: Signalment, clinical signs before and after surgery, results of microscopic examination of eviscerated intraocular tissues, follow-up information, and necropsy findings, if available, were recorded for each animal. RESULTS: Five dogs and 1 cat had primary intraocular neoplasms. Two of the dogs developed regrowth of the neoplasm around the ISP 6 to 24 months after implantation, and the eyes were enucleated. The cat developed signs compatible with systemic metastasis 4 years after surgery and was euthanatized. Three dogs had multicentric or metastatic neoplasia involving the eye. Two of these dogs were euthanatized because of their systemic disease 1.5 to 7 months after ISP implantation. The third dog is alive without evidence of regrowth 3 years after surgery. CLINICAL IMPLICATION: Intraocular neoplasia is not an absolute contraindication to ISP implantation.

Incidence of sudden infant death syndrome in Olmsted County, Minnesota: 1945 through 1992.

OBJECTIVE: To apply uniform diagnostic criteria for sudden infant death syndrome (SIDS) for an extended period for comparison of incidence rates from 1945 to 1992 in Olmsted County, Minnesota, to investigate the influence of a person-time or live birth denominator on the estimate of incidence, to calculate the proportionate mortality rate for SIDS over time, and to evaluate the accuracy of death certificates for case ascertainment and the role of interobserver variation in case classification. DESIGN: We retrospectively reviewed the autopsy results and complete medical records for all infant death from 1945 through 1992 for residents of Olmsted County, Minnesota. MATERIAL AND METHODS: Cases were identified from a computerized list of all Olmsted County deaths of infants occurring at ages 48 hours to 365 days. All resident cases were categorized as non-SIDS, possible SIDS, SIDS, or incomplete, on the basis of findings from autopsy and clinical history. Incidence rates were calculated for two different SIDS groups and with use of denominators of person-time and live births. RESULTS: For the study period, 82 cases of SIDS were identified (97% white and 3% Asian). The mean age at death was 12.5 weeks; male infants constituted 59% of cases. No significant trend in seasonal distribution was noted; 73% of deaths occurred between midnight and noon. The incidence rate, defined as SIDS definite and possible deaths per 1,000 resident live births, increased from 0.55 in 1950 through 1953 to 1.28 in 1990 through 1992. The secular trend was best described by a linear model with constant positive slope. Similar trends were observed with other definitions of incidence. During the study period, SIDS as a percentage of total infant deaths dramatically increased, ranging from 2.5 in 1950 through 1953 to 17.9 in 1990 through 1992. The death certificate diagnosis correctly predicted 72% of SIDS cases before 1970 and 100% of cases after 1970. CONCLUSION: Since 1945, the incidence of SIDS apparently has increased, although diagnostic transfer from other causes of death probably contributes to the observed trend. The comparison of live births versus person-time as denominators showed no significant difference in incidence rates. Interobserver reliability is modest for SIDS cases diagnosed before 1970 and may contribute to the variability in reported SIDS incidence rates.

Uveal malignant melanoma in a duck.

An adult male Muscovy (Cairina moschata) X Peking (Anas platyrhynchos) duck had a primary malignant uveal melanoma with periocular extension involving the left eye. The periocular mass displaced the globe 1.5 cm laterally. Thoracic metastasis of the ocular neoplasm infiltrated the pectoral muscles, rib cage, and cranial lung lobe on the left side, causing diminished voluntary motion of the left wing. The left orbit was exenterated, but tumor regrowth was evident within 2 weeks. This case was unusual because melanocytic neoplasms are rare in birds.

Traumatic ocular proptoses in dogs and cats: 84 cases (1980-1993).

Eighteen eyes of 66 dogs were visual on reevaluation of traumatic proptosis. Twenty-one eyes were enucleated, and 4 dogs were euthanatized. In 18 cats, no eyes regained vision after traumatic proptosis: 12 cats had the affected eye enucleated, 2 had an eye that was considered blind, and 4 cats were euthanatized. Affected eyes of 45 dogs and 2 cats underwent surgical replacement and temporary tarsorrhaphy. Favorable prognostic indicators for eyes undergoing surgical replacement included proptosis in a brachycephalic dog, positive direct or consensual pupillary light response, normal findings on posterior segment examination, and a proptosed eye that had vision on initial examination. Unfavorable prognostic indicators included proptosis in a nonbrachycephalic dog, proptosis in cats, hyphema, no visible pupil, facial fractures, optic nerve damage, and avulsion of 3 or more extraocular muscles.

Histological findings in corneal stromal abscesses of 11 horses: correlation with cultures and cytology.

Histopathology was compared to culture results and cytology from horses with corneal stromal abscess at the Auburn University and the Ohio State University Veterinary Teaching Hospitals. Significant bacteria were not isolated in culture or seen on histopathology in any of the horses. Although most bacteria infecting equine corneas can be isolated with blood and MacConkey's agars, failure to detect bacterial growth may not rule out infection because anaerobic or intracellular bacteria would not be isolated. The inability to visualise bacterial organisms on histological sections did not rule out their presence in the tissue, because there is often destruction of bacteria by neutrophils, macrophages and antibiotic therapy greatly reducing their numbers. Fungal keratitis was diagnosed by histopathology in 4 of 11 eyes (36%) and keratitis with no aetiological agent in 7 of 11 eyes (64%). Nine of 11 horses (82%) had a prominent neutrophilic stromal infiltrate and 2 (18%) had a predominantly pyogranulomatous reaction. Two of the 4 lesions that showed histological evidence of fungal infection were positive for identifiable fungi on culture and cytology. Fungal cultures of the other 2 cases with histological evidence of mycotic keratitis were negative or grew unidentifiable fungi which were considered pathogenic because, on histopathological sections, fungal hyphae were found deep in the corneal stroma surrounded by an inflammatory reaction. In 3 of 6 cases where fungi were recovered on culture, they were considered contaminants based on lack of evidence of organisms in histopathological sections. Histopathology and the use of special stains were important in the interpretation of culture and cytology results.

Evaluation of the safety and efficacy of vaccination of nursing pigs with living tachyzoites of two strains of Toxoplasma gondii.

The safety of vaccination and persistence and distribution of Toxoplasma gondii stages within tissues following vaccination were examined in 3-day-old nursing pigs vaccinated with living tachyzoites by intravenous and subcutaneous routes of either the TS-4 mutant strain or its parent RH strain of T. gondii. The efficacy of vaccination of nursing pigs with the TS-4 mutant was also examined in pigs challenged orally with oocysts following vaccination. Pigs were vaccinated with 3 x 10(5) living tachyzoites when 3 days old and boosted with 3 x 10(5) living tachyzoites when 17 days old. Group 1 had 2 pigs vaccinated intravenously (i.v.) with Hanks' balanced salt solution (HBSS) and served as a vaccination control. Group 2 and 5 pigs vaccinated i.v. with tachyzoites of the TS-4 mutant; 3 pigs were used to examine the safety, persistence, and distribution of the TS-4 mutant and 2 were used for oocyst challenge. Group 3 had 5 pigs vaccinated i.v. with tachyzoites of the RH strain and all were used to examine the safety, persistence, and distribution of the RH strain within their tissues. Group 4 had 3 pigs vaccinated subcutaneously (s.c.) with tachyzoites of the TS-4 mutant; 1 was used to determine the persistence and distribution of the TS-4 mutant within its tissues and the other 2 pigs were used for GT-1 oocyst challenge studies. Group 5 had 3 pigs vaccinated s.c. with tachyzoites of the RH strain and all were used to examine the safety, persistence, and distribution of the RH strain within their tissues. None of the control pigs or pigs vaccinated with the TS-4 mutant developed clinical signs of disease or died prior to oocyst challenge. The TS-4 mutant was not reisolated from the tissues of vaccinated pigs nor were microscopic lesions present in the tissues of pigs that had been killed and examined at necropsy. Severe disease with clinical signs consisting of dyspnea, inactivity, diarrhea, and ocular lesions was observed in the group 3 pigs vaccinated i.v. with the RH strain. One pig died 7 days after initial vaccination. Microscopic lesions were observed in numerous tissues of all group 3 pigs. Swelling, erythema, and ulcers were observed at the site of inoculation in the group 5 pigs that were vaccinated s.c. with the RH strain. Minimal to no microscopic lesions were observed in these group 5 pigs. The RH strain was reisolated from pigs in both groups vaccinated with this strain.(ABSTRACT TRUNCATED AT 400 WORDS)

Modified lateral orbitotomy for removal of orbital neoplasms in two dogs.

A simplified lateral orbitotomy is described that decreases surgical time and lessens tissue dissection, yet maintains the exposure to the orbit provided by other orbitotomy techniques. The approach involves cutting the orbital ligament, incising the temporalis aponeurosis from the dorsal zygomatic arch, making parallel zygomatic arch osteotomies, and reflecting the zygomatic arch ventrally. Closure of the wound involves wiring the zygomatic arch back into place. This orbitotomy procedure provides excellent exposure for removal or biopsy of orbital masses. The use of this technique for surgical excision of orbital masses in two dogs, one with an adenoma of the third eyelid gland and one with an orbital fibrosarcoma, and their subsequent management is described.

Scanning electron microscopy of intraocular lenses that had been implanted in dogs.

Scanning electron microscopy was used to evaluate changes on the surfaces of polymethylmethacrylate (PMMA), silicone, and polyhydroxyethylmethacrylate (HEMA) intraocular lenses (IOL) that had been implanted in the anterior chambers of the right eyes of 15 dogs. Five dogs received PMMA IOL; 5 dogs received silicone IOL; and 5 dogs received HEMA IOL. Twenty-eight days after surgery, the IOL were removed and processed for scanning electron microscopy. Nonimplanted IOL of each type were processed identically for comparison. Implanted PMMA IOL had significantly more debris and macrophages on their surfaces than did silicone IOL or HEMA IOL. Silicone IOL had significantly less fibrin deposition than did PMMA or HEMA IOL. Silicone IOL had surface defects attributable to handling by surgical instruments. Implanted HEMA IOL had multiple pits that appeared to be caused by biodegradation.

Clinicopathologic findings after experimental implantation of synthetic intraocular lenses in dogs.

Clinical findings indicate that canine eyes tolerate implantation of polymethylmethacrylate (PMMA) intraocular lenses (IOL) well, although inflammation and ocular damage attributable to the implants is not known. The use of silicone or polyhydroxyethylmethacrylate (HEMA) IOL has not been reported in dogs. In this study, 15 conditioned, mixed-breed dogs were allotted to 3 groups: 5 received PMMA IOL; 5 received silicone IOL; and 5 received HEMA IOL. The IOL optic was inserted into the anterior chamber of the right eye and anchored to the cornea. An identical surgical procedure was done on the left eye, except that no lens optic was inserted. Clinical examination and measurement of corneal thickness were done immediately prior to and after surgery. Aqueous humor samples were collected at the time of surgery and 28 days after surgery. Only mild and transient inflammation was observed in IOL-implanted eyes. On several postoperative days, it was found that PMMA IOL induced significantly greater corneal thickness, aqueous flare, anterior uveal irritation, and corneal edema than did other IOL. Significantly more anterior uveal irritation and increased aqueous humor protein concentration was observed with HEMA IOL than with PMMA or silicone IOL. Silicone IOL induced significantly less fibrin deposition than did PMMA or HEMA IOL.

Corneal thickness measured by ultrasonic pachymetry in cats.

Ultrasonic pachymetry was used to measure central, superior peripheral, and temporal peripheral corneal thickness of 35 cats (70 eyes) with normal corneas, anterior chambers, and intraocular pressures. Mean central corneal thickness for both eyes in 3 locations for 35 cats was 578 +/- 64 microns. Significant differences did not exist between central and peripheral corneal thickness. Corneal thickness increased significantly (P < 0.0001) with age up to 100 months. There was no significant difference in corneal thickness with regard to sex of the cats when adjusted for age.

Diagnosis and treatment of lens diseases.

The lens represents a unique tissue in light of its embryologic development, retention of old cells and nuclear make-up, transparent nature, immune privileged status, and metabolic restrictions. Disorders of malformation and malposition occur, but cataract development is the most common and significant problem for owners and animals. Technologic and pharmacologic advances have allowed surgical removal of equine cataracts to become an acceptable alternative, capable of returning a visually impaired horse to a functional status. Uveal inflammation represents the greatest threat to successful surgical cataract removal. Veterinarians should consult with those versed in ophthalmology for assistance in diagnosis, prognosis, peroperative treatment, surgical intervention, and follow-up on lens disorders.